<%
layout("/inc/layout.html",{
title:'残联监护人信息 - 残联申请 - 智慧洛龙',
keywords:'残联监护人信息,残联申请,智慧洛龙',
description:'残联监护人信息,残联申请,智慧洛龙',
style:'index.css'
}){
%>
<section class="container">
	<div class="row mt15 text-left">  
	    <ul class="breadcrumb">
	    	<li>当前位置：</li>
			<li><a href="/">主页</a></li>
	        <li><a href="/list/1">个人办事</a></li>
	        <li>残联申请</li>
	    </ul>
    </div>
</section>
<section class="container">
	<div class="row">
		<div class="panel panel-info">
			<div class="panel-heading text-left">
				<ul class="nav nav-tabs">
					<li class="active"><a href="/disabilityApply/base"><b>残联申请</b></a></li>
					<li><a href="/disabilityChange/base"><b>残联变更</b></a></li>
					<li><a href="/disabilityReapply/reapply"><b>残联补办</b></a></li>
					<li><a href="/disabilityCancel/cancel"><b>残联注销</b></a></li>
				</ul>
			</div>
			<div class="panel-body">
				<legend>
					<span class="text text-danger" id="messageCode">监护人信息</span>
				</legend>
				<form class="form-horizontal" id="disabilityInfo">
					<input id="id" type="text" name="id" style="display: none;" value="${id}">
			  		<div class="col-sm-offset-1 col-md-10">
				  		<div class="form-group">
						    <label class="col-sm-2 control-label">姓名</label>
						    <div class="col-sm-8">
					      		<input type="text" class="form-control" placeholder="请输入监护人姓名" name="guardianName" value="${apply.guardianName!}">
						    </div>
				  		</div>
				  		<div class="form-group">
						    <label class="col-sm-2 control-label">与监护人关系</label>
						    <div class="col-sm-8">
					      		<input type="text" class="form-control" placeholder="请输入与监护人之间的关系" name="guardianRelation" value="${apply.guardianRelation!}">
						    </div>
				  		</div>
				  		<div class="form-group">
						    <label class="col-sm-2 control-label">联系电话</label>
						    <div class="col-sm-8">
					      		<input type="text" class="form-control" placeholder="请输入联系电话" name="guardianTel" value="${apply.guardianTel!}">
						    </div>
				  		</div>
				  		
			  		</div>
				</form>
			</div>
			<div class="panel-footer">				
				 <div class="col-sm-offset-3 clearfix">
                    <div class="mt5 mb5 block col-sm-3">
                       <button id="back" id="submitAgent" class="btn btn-danger btn-lg btn-outline btn-block">上一步</button>
                    </div>
                    <div class="mt5 mb5 block col-sm-3">
                        <button id="doSubmit" id="submitAgent" class="btn btn-danger btn-lg btn-outline btn-block">下一步</button>
                    </div>
                </div>
			</div>
		</div>
	</div>
</section>
<% } %>
<script>
    require(['modules/disability_apply'], function (apply) {
        apply.people();
    });
</script>
</body>
</html>
